    <form>
        <div>
            <label>Title:</label>
            <input id='title' class="field" type="text" />
        </div>
        <div>
            <label>Assigned to</label>
            <select id="assigned_to" name="assigned_to">
                <option value="">-Select-</option>
                <option value="1">Employee 1</option>
                <option value="2">Employee 2</option>
                <option value="3">Employee 3</option>
                <option value="4">Employee 4</option>
            </select>
        </div>
        <div id="time-period">
            <label>Time Period</label>
            <select value="from-hour">
                <option value="">-Hour-</option>
            </select>
            <select value="from-date">
                <option value="">-Date-</option>
            </select>
            <select value="from-month">
                <option value="">-Month-</option>
            </select>
            <select value="from-year">
                <option value="">-Year-</option>
            </select>
            ----
            <select value="to-hour">
                <option value="">-Hour-</option>
            </select>
            <select value="to-date">
                <option value="">-Date-</option>
            </select>
            <select value="to-month">
                <option value="">-Month-</option>
            </select>
            <select value="to-year">
                <option value="">-Year-</option>
            </select>
        </div>
    </form>
